NHS to issue new advice after patients get kidneys from donor with cancer

NHS to issue new advice after patients get kidneys from donor with cancer
Improved co-ordination between hospitals and the transplant service is among recommendations after the incident

James Meikle
guardian.co.uk
Sunday 21 August 2011 13.33 BST

Organ transplant officials are planning new measures intended to prevent any repeat of an incident in which two patients were given kidneys from a donor who had a rare and aggressive form of cancer.

Improved co-ordination between surgeons and staff in different hospitals and the transplant service will be among a series of recommendations by NHS Blood and Transplant (NHSBT).

The patients involved in transplants at the Liverpool Royal University hospital last November underwent six cycles of chemotherapy treatment to clear the cancer. They have recently been told there was no sign of the lymphoma in their donated kidneys.

Guidance to clinicians on obtaining consent from patients and warning them of risks – including from donor-donated tumours – was already being prepared before the incidents and has now been circulated. NHSBT is also compiling a register of such incidents, and further advice will be issued after the Liverpool case.

NHSBT says it does everything it can to make sure organs are deemed fit for transplant. But the service has previously warned that postmortems on donors before transplantation are impossible as they would take too long and render organs unusable, and that most lymphomas could not be detected by blood tests.

The transplants involved kidneys from a woman who was later found to have had a hard-to-spot form of cancer called intravascular B-cell lymphoma. The two recipient patients, Robert Law and Gill Smart, have made formal complaints against the NHS.

Law told the Guardian: "I have had the results of a biopsy and a CT Pet scan from my doctors and have been told that all is clear and there is no sign of lymphoma in my newly transplanted kidney. I felt a wave of relief, which only lasted a short time, and now I am back to dealing with my transplant and overcoming the chemo. It's going in the right direction."

Smart said: "I was relieved but did not feel elated. I think it is my body reacting not just to the last eight months but to the last three years (when concerns were first raised about her kidney function) and I have had to keep a stiff upper lip."

James Neuberger, NHSBT's associate medical director, said: "NHSBT has had discussions with medical directors at both the donor and recipient hospitals about this situation. Whilst we are pleased to hear that the patients involved in this situation have had a positive response to their treatment we are keen to put in place measures to ensure this does not happen again.

"We are currently finalising a number of recommendations, including improving communication among specialist nurses, organ donation, recipient transplant co-ordinators and surgeons."

He added: "We would like to stress that this situation is uncommon and that everything possible is always done to reduce the risk of any transmissible diseases. When patients are registered for a transplant they are given a full explanation of the risks surrounding transplantation. No transplant is risk free, but we do everything we can to make sure that any organ offered up for transplant is tested and deemed fit for transplant.

"A transplant may be the only possible treatment for some people, who would die without one. In a situation where there are not nearly enough organs available for the number of transplants required, it often comes down to a balance of risk and benefit. Guidance is available that sets out the risks and benefits of when an organ should be used. Ultimately this is a decision for the clinician, the patient and their family."

http://www.guardian.co.uk/society/2011/aug/21/nhs-organ-donations-kidneys-cancer